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Impact of serum caffeine monitoring on adverse effects and chemotherapeutic responses to caffeine-potentiated chemotherapy for osteosarcoma
Journal of Orthopaedic Science, 06/10/09

Hayashi K et al. - In a trial to assess the use of monitoring and adjusting serum caffeine levels during caffeine-potentiated chemotherapy to reduce adverse effects it was concluded that monitoring and adjusting caffeine levels were achieved without apparent loss of chemotherapeutic efficacy.

• A method for rapidly determining caffeine concentration by high-performance liquid chromatography was utilized.
• The maximum caffeine concentration was predicted from the measured concentrations at 24 and 48 hr after the beginning of caffeine administration.
• Caffeine infusion rate was then modified accordingly to prevent the expected final concentration from exceeding 80 ?g/ml.
• The study involved 22 American Joint Committee on Cancer (AJCC) stage IIB high-grade osteosarcoma pts treated with caffeine-potentiated chemotherapy.
• 9 pts underwent monitoring of their serum caffeine levels (monitoring group), and the remaining 13 pts were not monitored (nonmonitoring group).
• Toxicities were graded according to the Japan Clinical Oncology Group Toxicity Criteria.

• Hematological toxic events were well tolerated in both groups.
• Grade 4 leukocyte toxicity events occurred in both groups.
• In the nonmonitoring group, grade 2 or higher toxicities included 5 elevated aspartate aminotransferase/alanine aminotransferase level events and 17 hyponatremia events vs 1 hyponatremia event in the monitoring group.
• Histological examination of excised tumor samples after preoperative chemotherapy revealed that chemotherapeutic efficacy in the monitoring group was as good as in the nonmonitoring group.
• Median follow-up period in all pts was 72 mos.
• Event-free survival was 76%, and overall survival was 100%.

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